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Head and neck cancer (HNC) represents the sixth most common neoplasm worldwide, accounting for 800,000 new cases and 400,000 deaths globally every year. The locally advanced HNC (LA-HNC) requires chemotherapy with high dose cisplatin, a nephrotoxic agent able to damage renal function both in acute and chronic asset. Moreover, this necessary aggressive oncological regimen increases the rate of malnutrition, catabolism and sarcopenia in the majority of patients, making the nutritional therapy an essential cornerstone of the multidisciplinary approach in the management of LA-HNC. International guidelines highlight that aim for energy and protein intakes of at least 30-35kcal/kg/day and 1.2g protein/kg/day should be the most appropriate dietary strategy to reduce the risk of malnutrition and to allow patients to tolerate the chemoradiotherapy protocol. However, it is debatable if a high dose protein diet in this asset of patients could compromise the global renal function which is already under pressure of the nephrotoxic effect of platinum over time. Aim of our study was to evaluate the impact of a nephrotoxic agent on renal function a consecutive cohort of LA-HNC who underwent three cycles of high dose cisplatin concomitant to radiotherapy.
A consecutive cohort of 60 pts was enrolled between 2021-2023. Each patient underwent an oncological and nutritional evaluation and was subsequently subjected to a high calorie&protein diet integrated with oral nutritional supplements (ONS) for a period of 5 months (during 6 weeks of high dose cisplatin chemotherapy concomitant to radiotherapy and in following 3 months). Bioimpedence analysis, lab test exams and clinical variables were examined at baseline, at the end of the treatment and after 3 months. Statistical analysis were performed with IBM SPSS statistics v.24.0. Log Rank test were performed for paired nonparametric test between two time-points. Related-samples Friedman’s two-way analysis of variance by ranks was employed to test distribution differences among three time-points. P<0.05 were considered significant. Bonferroni corrections were used for multiplicity test.
Descriptive analysis is showed in tables 1 and 2. Our results clearly highlighted that cisplatin influenced dramatically every clinical and laboratory parameters from T0 to T1, especially in term of nutritional status with a strong impact on the onset of sarcopenia despite a high protein diet with ONS. Nevertheless, the severity of feeding problems caused by side effects of the treatments lead to the conclusion that HCPD is required to improve muscle mass from T1 to T2. In term of medium eGFR decay, the chemotherapy is able to reduce the renal function of about 8 ml/min/1.73 in 5 months, therefore harboring some cases of mild acute kidney injury (AKI) and acute kidney disease (AKD). However, the HCPD remains fundamental in this set of patients to avoid sarcopenia and malnutrition, allowing all the selected cohort to complete the oncological regimen without cases of severe AKI or AKD requiring RRT during the treatment.
The LA-HNC represents a very challenge setting of oncological patients both for the aggressiveness of the tumor and for the nephrotoxicity of chemotherapy based on high dose cisplatin. The used of HCPD, even though apparently controversial for a population at high risk of AKI due to platinum effect, remains nowadays the most promising dietary approach able to allow patients to support therapy avoid severe stages of AKI and AKD and malnutrition.